Tacrolimus rescue therapy in resistant or relapsing cases of primary glomerulonephritis.
BACKGROUND
Patients with resistant or relapsing primary glomerulonephritis (PGN) after conventional immunosuppressive treatment have a worse renal outcome, and treatment of these patients remains problematic. In this study we aimed to determine the effect of tacrolimus in these patients.


METHODS
We prospectively studied 15 patients with PGN (3 membranous nephropathy, 6 membranoproliferative GN, 4 focal segmental glomerulosclerosis [FSGS], 1 IgA nephropathy and 1 IgM nephropathy) who were either resistant (n=7) or relapsing (n=8) after or during conventional immunosuppressive therapy. Tacrolimus was started at a dosage of 0.05 mg/kg per day. Prednisolone was either maintained or added to the tacrolimus regimen.


RESULTS
The mean duration of tacrolimus treatment was 28.9 +/- 2.4 months. Proteinuria decreased from 6.3 +/- 5.0 g/day to 0.5 +/- 0.6 g/day at the end of follow-up (p=0.001). Complete or partial remission was achieved by 60% and 40% of patients, respectively. Relapse occurred in only 2 patients with FSGS under tacrolimus treatment. There was no significant change in serum creatinine at the end of follow-up (from 1.4 +/- 1.0 mg/dL to 1.2 +/- 0.6 mg/dL, p=0.3). Serum albumin increased from 3.2 +/- 0.5 g/dL to 4.3 +/- 0.3 g/dL (p=0.0001). There were 6 relapses among 10 patients after the withdrawal of tacrolimus.


CONCLUSIONS
These data suggest that the combined therapy of tacrolimus and low-dose prednisolone may have a promising role to obtain long-term remission in resistant or relapsing PGN.
Arikan
Hakki
H
Division of Nephrology, Department of Medicine, Marmara Medical School, Istanbul - Turkey. ihakkiarikan@yahoo.com
Koc
Mehmet
M
Cakalagaoglu
Fulya
F
Eren
Zehra
Z
Segal
Mark S
MS
Tuglular
Serhan
S
Ozener
Cetin
C
Akoglu
Emel
E
D000328:Adult; D003404:Creatinine / Q000097:blood; D005260:Female; D005921:Glomerulonephritis / Q000097:blood / Q000188:drug therapy* / Q000652:urine; D006801:Humans; D007166:Immunosuppressive Agents / Q000009:adverse effects / Q000627:therapeutic use*; D008297:Male; D008875:Middle Aged; D011507:Proteinuria; D012008:Recurrence; D012074:Remission Induction; D016559:Tacrolimus / Q000009:adverse effects / Q000627:therapeutic use*; D055815:Young Adult
D007166:Immunosuppressive Agents; D003404:Creatinine; D016559:Tacrolimus